腹腔镜与内镜逆行胰胆管造影在二次胆道手术中的应用  

Application of laparoscopic and endoscopic retrograde cholangiopancreatography in secondary biliary surgery

作　　者：石余[1] 王方平[1] SHI Yu;WANG Fang-ping(Department of Hepatobiliary Surgery,Xinchang People's Hospital Affiliated Wenzhou Medical University,Shaoxing 312500,China)

机构地区：[1]新昌县人民医院肝胆外科,浙江绍兴312500

出　　处：《腹腔镜外科杂志》2021年第11期847-850,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨内镜逆行胰胆管造影(ERCP)失败后同期行腹腔镜胆总管探查(LCBDE)二次胆道手术的安全性。方法:回顾分析2016年1月至2020年1月为62例复发胆总管结石患者行LCBDE二次胆道手术的临床资料,其中ERCP失败后同期行LCBDE的26例患者为观察组,直接行LCBDE的36例患者为对照组。对比分析两组胆总管结石清除率、手术时间、术中出血量、中转开腹率、术后并发症发生率、术后通气时间、住院时间、住院费用。结果:两组患者临床资料差异无统计学意义,胆总管结石清除率均在90%以上,无死亡病例。观察组手术时间、住院费用高于对照组,差异有统计学意义(P<0.05);两组胆总管结石清除率、术中出血量、中转开腹率、术后并发症发生率、术后通气时间、住院时间差异无统计学意义(P>0.05)。结论:ERCP失败的患者同期行LCBDE的二次胆道手术是安全、有效的。如果预期ERCP失败或ERCP术后并发症风险较高,LCBDE二次胆道手术应被视为胆总管结石的一线治疗,否则可能增加ERCP失败后同期行LCBDE的手术时间与住院费用。Objective:To investigate the safety of application of laparoscopic common bile duct exploration(LCBDE)in secondary biliary tract operation after failure of endoscopic retrograde cholangiopancreatography(ERCP).Methods:In this retrospective study,clinical data of 62 patients with recurrent choledocholithiasis who underwent secondary choledocholithotomy with LCBDE from Jan.2016 to Jan.2020 were analyzed.Among them,26 patients who underwent LCBDE after failed ERCP were in the observation group,36 patients who directly underwent LCBDE were in control group.The baseline clinical data of the two groups before operation were collected and the choledocholithiasis clearance rate,operation time,intraoperative bleeding volume,rate of conversion to open surgery,postoperative complication incidence,postoperative ventilation time,hospital stay and hospitalization cost of the two groups were comparatively analyzed.Results:There was no significant difference in baseline clinical characteristics between the two groups before operation.The clearance rate of choledocholithiasis in the two groups was more than 90%,and there was no death in the two groups.The average operation time and hospitalization cost of patients in the observation group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).There was no significant difference between the observation group and the control group in the rate of choledocholithiasis removal,the amount of bleeding during operation,rate of conversion to open surgery,postoperative complication rate,postoperative ventilation time and hospital stay(P>0.05).Conclusions:It is safe and effective for patients with failed ERCP to undergo LCBDE at the same time in secondary choledocholithotomy.If the risk of ERCP failure or complications after ERCP is expected to be high,LCBDE secondary biliary surgery should be considered as the first-line treatment of choledocholithiasis,otherwise it will increase the operation time and hospitalization cost of LCBDE pa

关 键 词：胆总管结石 胆总管探查 腹腔镜检查 胰胆管造影术 内窥镜逆行 

分 类 号：R657.4[医药卫生—外科学]